Provider Demographics
NPI:1679629554
Name:BUTLER, MAXINE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:MAXINE
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 MARLTON PIKE E
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2139
Mailing Address - Country:US
Mailing Address - Phone:856-751-0194
Mailing Address - Fax:856-751-6201
Practice Address - Street 1:1916 MARLTON PIKE E
Practice Address - Street 2:SUITE 2
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2139
Practice Address - Country:US
Practice Address - Phone:856-751-0194
Practice Address - Fax:856-751-6201
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001389001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ604054Medicare ID - Type Unspecified